HumanFIRST Laboratory, Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA.
U.S. Army Futures Command, CCDC Soldier Center Simulation and Training Technology Center, Orlando, FL 32826, Orlando.
Mil Med. 2024 Nov 5;189(11-12):e2447-e2454. doi: 10.1093/milmed/usae277.
The use of tourniquets in combat medicine continues to be a key focus as they have consistently been shown to combat one of the leading causes of preventable death on the battlefield, massive hemorrhage to extremities. The present study analyzed tourniquet application among combat medics (68W) and combat lifesavers (CLSs) in a training environment to determine whether trainees' performance is consistent among one another and whether performance can be associated with participant demographics such as experience or role.
Study participants treated male and female patient simulators within a tactical field care phase, both of which experienced an amputated leg and required the application of a Combat Application Tourniquet (CAT). To assess tourniquet application variability and performance, a series of application subtasks and potential errors were measured via video coding of the scenarios by a team of 5 coders. Time to tourniquet application and tourniquet application duration were also coded to assess correlations between application duration and variability or performance.
Results from analyzing tourniquet application subtasks and errors through a series of one-way ANOVA tests showed that application of the CAT first, hasty CAT application, and high tourniquet application were not predictive of participant role, time within the role, and self-reported tourniquet skill, confidence, or experience. Such demographic variables were also not predictive of successful tourniquet application as defined by the number of windlass rod rotations. Results from binomial logistic regressions showed that participant role and self-reported tourniquet skill and experience were predictors of tourniquet application duration.
The findings suggest that high variability in CAT application methodology and performance exists among CLS and combat medics, which is largely not predictable by various demographics such as role, experience within the designated role, and self-reported confidence, skill, or experience. The observed disconnect between training or experience and CAT application performance suggests substantial variability in the consistency of training for both CLS and 68W soldiers. These inconsistencies may stem from variability in instructor knowledge, teaching styles, or training materials or may be developed through informal methods such as experiences in the field or recommendations from colleagues and experts. These findings highlight a potential need to reassess CAT application training, particularly in regard to consistency and validation. Finally, it should be noted that the study's findings may be limited or fail to capture some study effects because of the sample size and wide range of reported experience among participants.
在战伤医学中，使用止血带仍然是一个关键焦点，因为它们一直被证明可以对抗战场上导致可预防死亡的主要原因之一，即四肢大出血。本研究分析了在训练环境中战斗医护人员（68W）和战斗救生员（CLS）使用止血带的情况，以确定受训者之间的表现是否一致，以及表现是否可以与参与者的特征（如经验或角色）相关联。
研究参与者在战术现场护理阶段治疗男性和女性模拟患者，他们都经历了腿部截肢，需要应用战斗应用止血带（CAT）。为了评估止血带应用的可变性和性能，通过一组 5 名编码员对场景进行视频编码，测量了一系列应用子任务和潜在错误。应用止血带的时间和止血带的应用时间也被编码，以评估应用时间与可变性或性能之间的相关性。
通过一系列单向方差分析测试分析止血带应用子任务和错误的结果表明，首先应用 CAT、仓促应用 CAT 和高止血带应用并不能预测参与者的角色、在角色中的时间以及自我报告的止血带技能、信心或经验。此类人口统计学变量也不能预测成功应用止血带，因为成功应用止血带的定义是风轮杆旋转的次数。二项逻辑回归的结果表明，参与者的角色以及自我报告的止血带技能和经验是止血带应用时间的预测因素。
研究结果表明，CLS 和战斗医护人员之间存在 CAT 应用方法和性能的高度可变性，这些可变性在角色、指定角色内的经验以及自我报告的信心、技能或经验等各种人口统计学变量中很大程度上是不可预测的。在 CAT 应用性能方面，观察到培训或经验与 CAT 应用性能之间存在脱节，这表明 CLS 和 68W 士兵的培训一致性存在很大差异。这些差异可能源于教官知识、教学风格或培训材料的差异，也可能是通过现场经验或同事和专家的建议等非正式方法形成的。这些发现突出表明，需要重新评估 CAT 应用培训，特别是在一致性和验证方面。最后，应该注意的是，由于参与者报告的经验范围很广，样本量小，研究结果可能存在局限性或无法捕捉到某些研究效果。
